1669972790 NPI number — MRS. JULIE LYNNE MOLLICA LICENSED INDEPENDENT

Table of content: MRS. JULIE LYNNE MOLLICA LICENSED INDEPENDENT (NPI 1669972790)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669972790 NPI number — MRS. JULIE LYNNE MOLLICA LICENSED INDEPENDENT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MOLLICA
Provider First Name:
JULIE
Provider Middle Name:
LYNNE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LICENSED INDEPENDENT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1669972790
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
456 FLAX POND ROAD
Provider Second Line Business Mailing Address:
BREWSTER TREATMENT PROGRAM, OLD COLONY YMCA
Provider Business Mailing Address City Name:
BREWSTER
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02631
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
508-896-9700
Provider Business Mailing Address Fax Number:
508-896-8706

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
456 FLAX POND ROAD
Provider Second Line Business Practice Location Address:
BREWSTER TREATMENT PROGRAM, OLD COLONY YMCA
Provider Business Practice Location Address City Name:
BREWSTER
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02631
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-896-9700
Provider Business Practice Location Address Fax Number:
508-896-8706
Provider Enumeration Date:
02/15/2018

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  1029770 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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